The marathon was first held in April 2000 when 3,230 men and 2,589 women completed the event. As popularity for the event grew, a half-marathon was added in 2002. This was soon followed by the addition of a kids marathon. A 5k run was added to the race options as well as wheelchair versions of marathon, half-marathon, and 5k races. The number of participants in the 2008 event exceeded 30,000 total entrants. Unlike some of Nashville's other marathons, e.g. Harpeth Hills Flying Monkey Marathon and Greenway Marathon, the Rock 'n' Roll Marathon is a qualifying event for the Boston Marathon.

Band stages featuring live musical entertainment are located along the course. Many bands and high school cheerleaders entertain runners and walkers, and friends, families, and neighbors join in cheering on participants. The marathon is followed by an evening concert which has previously featured Sara Evans, Phil Vassar, Jo Dee Messina, Brad Paisley, and Lee Roy Parnell among others.